Memorials and Tributes

Note: The form below is a printer-friendly version. You may complete it online, then print it for mailing, or you may print the form and fill it out in pen before mailing.

Enclosed is my donation of:
$100 $500 Other $

Please make checks payable to:
Schuylkill Healthcare Services, Inc.
(Contributions are tax deductible*)

Please send your donation to:

Attn: Development Office
The Pottsville Hospital and Warne Clinic
420 S Jackson St
Pottsville, PA 17901-9957

My Name:
Address:
City: State: Zip:
Daytime Phone:
E-Mail Address:

Please send a card:

In memory of:
In honor of:
In celebration of:

Graduation
Birth Other

 

Relationship to honoree

 

I would like my card sent to:

Name:
Address:
City: State: Zip:
Please sign
my card:

I have enclosed a matching gift form from my employer.

*Please consult with your tax consultant or financial planner